STUDY DESIGN: We have studied prospectively the clinical and radiological results after unilateral pedicle screw fixation in degenerative lumbar spinal stenosis. OBJECTIVE: To evaluate the clinical significance of unilateral pedicle screw fixation. SUMMARY OF LITERATURE REVIEW: The use of pedicle screw fixation has significantly increased fusion rate in degenerative lumbar spinal surgery. However, the rigid spinal fixation may result in deterioration of the juxta-fusion segments and lead to the stress-shielding of vertebral bodies within the stabilized segments. MATERIALS AND METHODS: From July 1997 to October 1998, we had performed bilateral posterolateral fusion and unilateral pedicle screw fixation for degenerative spinal stenosis in nign cases. The main indications for unilateral pedicle screw fixation included patients undergoing decompressive laminectomies, which preserved the facet joints. One of the patients was initially scheduled for bilateral pedicle screw fixation. However, during the application of the instrumentation, loosening of a pedicle screw was occurred. Only unilateral pedicle screw fixation on the contralateral side was kept. The clinical results were assessed the back pain, radiating pain and claudicaion. We assessed the radiologic results such as fusion status and maintenance of disc height. RESULTS: The back pains were improved in 6 cases , and the radiating pain and claudication were improved in eight cases after the operation. According to Lenke's grade, fusion status were showed grade A in nign segments and grade B in four segments at the last follow-up radiograph. The loss of disc height averaged 7.8(1-25)% in thirteen segments. CONCLUSION: Unilateral pedicle screw fixation is one of the useful methods for patients undergoing decompressive laminec-tomies, which preserve the facet joints in degenerative lumbar spinal stenosis.
Back Pain ; Follow-Up Studies ; Humans ; Laminectomy ; Prospective Studies ; Spinal Stenosis* ; Zygapophyseal Joint

Congenital myasthenic syndromes are a genetically and clinically heterogeneous group of neuromuscular disorders linked by abnormal signal transmission at the motor endplate caused by various genetic defects. Major clinical symptoms include weakness and fatigue during the first years of life but patients may also present with hypotonia, facial weakness, swallowing difficulties, respiratory dysfunction, ptosis and ophthalmoparesis. Here we report a 10-year-old boy who presented with mild developmental delay and bilateral ptosis caused by a frameshift mutation in the CHRNA1 gene that co-segregated within the family, and finally diagnosed as autosomal dominant congenital myasthenic syndrome.

Congenital myasthenic syndromes are a genetically and clinically heterogeneous group of neuromuscular disorders linked by abnormal signal transmission at the motor endplate caused by various genetic defects. Major clinical symptoms include weakness and fatigue during the first years of life but patients may also present with hypotonia, facial weakness, swallowing difficulties, respiratory dysfunction, ptosis and ophthalmoparesis. Here we report a 10-year-old boy who presented with mild developmental delay and bilateral ptosis caused by a frameshift mutation in the CHRNA1 gene that co-segregated within the family, and finally diagnosed as autosomal dominant congenital myasthenic syndrome.

Growth hormone (GH) and thyroid stimulating hormone (TSH)-secreting pituitary adenomas are very rare and they account for only 0.5% for all pituitary adenomas. These adenomas are usually treated with surgery, but this surgery is not easy because the tumor is usually huge and invasive. We reported here on a case of a GH-TSH-secreting adenoma in a 23-year-old male patient who was initially treated with octreotide LAR. He presented with symptoms of headache, palpitation and a visual defect that he had for the 3 months. He had hypertrophy of the frontal bone and enlargement of both the hands and feet. The visual field test showed bitemporal hemianopsia. The laboratory examinations showed high serum levels of free T4, TSH and free alpha-subunit. Additionally, the serum levels of GH and insulin-like growth factor-I (IGF-I) were increased. GH was not suppressed below 1microg/L by an oral 75g glucose loading test, and TSH was not stimulated by thyrotropin-releasing hormone (TRH). Because sellar MRI showed invasive macroadenoma encasing the vessels, we initially tried octreotide LAR for treatment. A year later, the IGF-I and thyroid function tests were normalized and the size of the tumor was reduced with cystic change. The symptoms of palpitation and headache were improved without a change of the visual field defect.
Acromegaly ; Adenoma ; Foot ; Frontal Bone ; Glucose ; Growth Hormone ; Hand ; Headache ; Hemianopsia ; Humans ; Hypertrophy ; Insulin-Like Growth Factor I ; Male ; Octreotide ; Pituitary Neoplasms ; Thyroid Function Tests ; Thyrotropin ; Thyrotropin-Releasing Hormone ; Visual Field Tests ; Visual Fields ; Young Adult

PURPOSE: The purpose of our study is to provide useful information for diagnostic methods of fatty liver by childhood simple obesity and to provide correlation between serum alanine aminotransferase (ALT) for screening test and abdominal computerized tomography (CT) and liver biopsy for confirmative diagnostic methods of fatty liver. METHODS: Among 78 obese childrens who visited our hospital, CT was carried out in 26 childrens. Of these, liver biopsy was carried out in 15 childrens who had high obesity index or severe elevated ALT. Based on the level of serum ALT, 26 cases were classified into 3 groups, and compared with physical measurements and degree of fatty infiltration on CT and liver biopsy. RESULTS: 1) Correlation between ALT and physical measurements: Of 26 obese children, ALT was abnormally elevated (>30 IU/L) in 17 cases (67.4%) but there was no significant correlation between ALT and physical measurements (p>0.05). 2) Correlation between degree of fatty infiltration on CT and ALT: Of 26 cases, 13 cases (50%) revealed fatty liver on CT. The degree of fatty liver on CT had significant correlation with elevation of ALT (p<0.05). 3) Correlation between the degree of fatty infiltration on liver biopsy and ALT: Liver biopsy was performed in 15 cases of which 14 cases revealed fatty liver. But one case had normal hepatic histology with severe obesity and normal ALT. Fourteen fatty liver cases on liver biopsy were classified into 3 groups by the degree of fatty infiltration and analysed with obesity index and ALT. The histologic hepatic steatosis had no significant correlation with obesity index (p>0.05), but significant correlation with ALT (p<0.05). 4) Correlation between CT and liver biopsy finding: Both CT and liver biopsy were performed in 15 cases of which 6 cases revealed normal finding on CT and 9 cases manifested fatty liver. There was significant correlation between CT and liver biopsy findings (r=0.6094). CONCLUSION: The results of our study suggest that abdominal CT and liver biopsy are useful and accurate methods of estimating fatty liver in the childhood obesity. But biochemical abnormalities of routine liver function tests dot not correlate well with severity of the fatty liver and liver injury.
Alanine Transaminase ; Biopsy* ; Child* ; Diagnosis* ; Fatty Liver* ; Humans ; Liver Function Tests ; Liver* ; Mass Screening ; Obesity* ; Obesity, Morbid ; Pediatric Obesity ; Tomography, X-Ray Computed*

BACKGROUND: The highly developed endoplasmic reticulum (ER) structure in pancreatic beta cells is heavily involved in insulin biosynthesis. Thus, any perturbation in ER function inevitably impacts insulin biosynthesis. Recent studies showed that the expression of tribbles-related protein 3 (TRB3), a mammalian homolog of Drosophilia tribbles, in various cell types is induced by ER stress. Here, we examined whether ER stress induces TRB3 expression in INS-1 cells and found that TRB3 mediates ER stress-induced suppression of insulin gene expression. METHODS: The effects of tunicamycin and thapsigargin on insulin and TRB3 expression in INS-1 cells were measured by Northern and Western blot analysis, respectively. The effects of adenovirus-mediated overexpression of TRB3 on insulin, PDX-1 and MafA gene expression in INS-1 cells were measured by Northern blot analysis. The effect of TRB3 on insulin promoter was measured by transient transfection study with constructs of human insulin promoter. RESULTS: The treatment of INS-1 cells with tunicamycin and thapsigargin decreased insulin mRNA expression, but increased TRB3 protein expression. Adenovirus-mediated overexpression of TRB3 decreased insulin gene expression in a dose-dependent manner. A transient transfection study showed that TRB3 inhibited insulin promoter activity, suggesting that TRB3 inhibited insulin gene expression at transcriptional level. Adenovirus-mediated overexpression of TRB3 also decreased PDX-1 mRNA expression, but did not influence MafA mRNA expression. CONCLUSIONS: This study showed that ER stress induced TRB3 expression, but decreased both insulin and PDX-1 gene expression in INS-1 cells. Our data suggest that TRB3 plays an important role in ER stress-induced beta cell dysfunction.
Blotting, Northern ; Blotting, Western ; Endoplasmic Reticulum ; Endoplasmic Reticulum Stress ; Gene Expression ; Humans ; Insulin ; Insulin-Secreting Cells ; RNA, Messenger ; Thapsigargin ; Transfection ; Tunicamycin

BACKGROUND: Chemerin is a novel adipokine that is associated with inflammation and adipogenesis. However, it remains unclear whether chemerin is involved in patients with cardiovascular disease. We investigated whether the serum chemerin levels of Korean patients with coronary artery disease correlated with specific cardiometabolic parameters. METHODS: In total, 131 patients, all of whom had coronary artery stenosis exceeding 50%, participated in this study. Their serum chemerin levels and cardiometabolic parameters were measured. The serum chemerin levels of two groups of patients were compared; those with one stenotic vessel (n=68) and those with multiple stenotic vessels, including left main coronary artery disease (n=63). RESULTS: Serum chemerin levels correlated positively with the degree of coronary artery stenosis and fasting glucose, triglyceride, total cholesterol, low density lipoprotein cholesterol, and high sensitive C-reactive protein levels. The group with multiple stenotic vessels, including left main disease, had higher chemerin levels than the group with one stenotic vessel (t=-2.129, P=0.035). Multiple binary logistic regression showed chemerin was not an independent risk factor of multiple vessel disease (odds ratio, 1.018; confidence interval, 0.997 to 1.040; P=0.091). CONCLUSION: Serum chemerin levels have a significant correlation with several cardiometabolic risk factors and the degree of coronary artery stenosis in Korean patients with coronary artery disease. However, multiple binary logistic regression showed chemerin was not an independent risk factor of multiple vessel disease. Additional investigations are necessary to fully elucidate the role of chemerin in cardiovascular disease.
Adipogenesis ; Adipokines ; C-Reactive Protein ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Fasting ; Glucose ; Glycosaminoglycans ; Humans ; Inflammation ; Lipoproteins ; Logistic Models ; Risk Factors

BACKGROUND AND AIMS: Various gastric and duodenal lesions with gastrofiberscopy were observed in patients with obstructive biliary disease. METHODS: A clinical analysis of the endoscopic findings was carried out on 88 patients with obstructive biliary disease, from February 1994 to January 1998, in the department of Internal Medicine, Chungnam National University Hospital. RESULTS: 1) In the 88 patients, sex distribution showed predominance in the males (47/41) and most of the cases involved those in their 60's. 2) The obstructive biliary diseases were included, common bile duct stones (53.4%), common bile duct cancer (18.2%), pancreatic cancer (18.2%), Klatskin tumor (4.5%) and common hepatic duct cancer (3.4%). 3) The gastroduodenal lesions involved in the obstructive biliary diseases were, erosive gastritis (22.7%), duodenal ulcer (8.0%), gastric ulcer (5.7%), and acute duodenitis (3.4%) in orders. CONCLUSIONS: Significant upper gastrointestinal lesions were found in obstructive biliary disease.
Chungcheongnam-do ; Common Bile Duct ; Duodenal Ulcer ; Duodenitis ; Gastritis ; Hepatic Duct, Common ; Humans ; Internal Medicine ; Klatskin's Tumor ; Male ; Pancreatic Neoplasms ; Sex Distribution ; Stomach Ulcer

BACKGROUND: The impact of the immune response on cancer gene therapy using viral vectors to deliver a "suicide gene" is currently unclear. A vigrous immune response targeted at viral proteins or transgene may enhance the efficacy of tumor destruction and even augment responses to tumor antigens. These responses may involve the release of cytokines and stimulation of tumor specific cytotoxic T-lymphocytes that enhance therapeutic efficacy. On the other hand, a vigorous rapid cellular immune response may destroy cells expressing the therapeutic gene and attenuate the response to therapy. Furthermore, development of neutralizing antibody responses may prevent readministration of virus, a potentially significant limitation. Evaluating the significance of these limitations in animal models and developing solutions are therefore of obvious importance. METHODS: After retroviral transduction of mouse mesothelioma cell line(AB12) with Herpes Simplex Virus thymidine kinase (HSVtk) gene in vitro, subcutaneous flank tumors were established. To study the effect of intact immune system on efficacy of tumor erradication, the ability of the HSVtk/ganciclovir system to inhibit tumor growth was compared among normal Balb/c mice, immunodeficient Balb/c-nude and SCID mice, and Balb/c mice immunosuppressed with cyclosporin. RESULTS: Ganciclovir treatment resulted in greater inhibition of tumor growth in Balb/c mice compared with immunodeficient Balb/c-nude mice and SCID mice(in immunodeficient mice, there were no growth inhibition by ganciclovir treatment). Ganciclovir treatment resulted in greater inhibition of tumor growth in non-cyclosporin (CSA) treated Balb/c mice compared with CSA treated Balb/c mice. On day 8, mean ganciclovir-treated tumor volume were 65% of control tumor volume in Balb/c mice versus 77% control tumor volume in CSA-treated Balb/c mice. This effect was still evident during therapy (day 11 and 13). On day 13, non-CSA treated tumor volume was 35% of control tumor volume versus 60% of control tumor volume in CSA treated Balb/c mice. Duration of expression of HSVtk was not affected by the immunosuppression with CSA. CONCLUSION: These results indicate that the immune responses against retrovirally transduced cells enhance the efficacy of the HSVtk/ganciclovir system. These findings have important implications for clinical trials using currently available retrovirus vectors as well as for future vector design.
Animals ; Antibodies, Neutralizing ; Antigens, Neoplasm ; Cyclosporine ; Cytokines ; Ganciclovir ; Genes, Neoplasm ; Genetic Therapy* ; Hand ; Herpes Simplex* ; Immune System* ; Immunity, Cellular ; Immunosuppression ; Mesothelioma ; Mice ; Mice, SCID ; Models, Animal ; Phosphotransferases* ; Retroviridae ; Simplexvirus* ; T-Lymphocytes, Cytotoxic ; Thymidine Kinase ; Transgenes ; Tumor Burden ; Viral Proteins ; Zidovudine

BACKGROUND AND AIMS: The objective of this paper is to compare the effectiveness of com-mon bile duct stone extraction by conditions and methods. METHODS: Endoscopic sphinc-terotomies with stone extraction were practiced in 71 patients with common bile duct stones by basket extraction, balloon extraction and mechanical lithotripsy. RESULTS: 1) In 71 patients with CBD stone, sex distribution showed predominence in females (56.3%) and most of the cases were over 60 years old. 2) After sphincterotomy, the overall success rate of the stone extraction was 87.3% (with balloon and basket or mechanical lithotrispy). The removal methods of the stone extractions were varied, but the most commonly used method was basket extraction (50.7%). 3) The complications of sphicterotomy were noted in 10 cases and in 8 cases minor bleeding was stopped with a hypertonic saline epinephrine injection. 4) After the stone extraction, counts and levels of leukocyte, aspartate transami-nase, alanine transaminase, alkaline phosphatase and total bilirubin were significantly improved (p <0.05). 5) Removal methods according to stone size did not show a signifi-cant difference, but the mean size of the stones was different. According to the several methods, the mean diameter of stones were different. The stone size was 1.1 cm in the case of spontaneous removal, 1.4 cm in balloon or basket removal, 1.9 cm in mechanical lithotripsy and 2.0 cm in surgical removal. CONCLUSIONS: Endoscopic stone extraction was effective and safe method with low rate of complications. However there were some significant difficulties in removing large or impacted stones, therefore EHL, ESWL or operation should be considered.
Alanine Transaminase ; Alkaline Phosphatase ; Aspartic Acid ; Bile Ducts ; Bilirubin ; Common Bile Duct* ; Epinephrine ; Female ; Hemorrhage ; Humans ; Leukocytes ; Lithotripsy ; Middle Aged ; Sex Distribution